Situación ponderal de la población escolar de 6 a 9 años en España: resultados del estudio ALADINO 2015

Differences in the temporal trends of childhood overweight and obesity in Spain in the 2011-2019 period by sex, age and socioeconomic level: results of the ALADINO study

INTRODUCTION

Childhood excess weight is a growing public health problem. The aim of this study was to assess temporal trends in the prevalence of overweight, obesity and central obesity in schoolchildren aged 6-9 years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics.

METHODOLOGY

The analysis included data from the 2011, 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6-9 years. We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity (defined according to the criteria of the World Health Organization and the International Obesity Task Force) and of central obesity, in addition to associated demographic and socioeconomic variables.

RESULTS

Between 2011 and 2019, the prevalence of overweight (WHO criteria) decreased in boys aged 6, 7 and 8 years (by -5.4%, -5.7% and -5.3%, respectively) and boys whose parents had a higher educational attainment (by -5.3%). In relation to the socioeconomic level, overweight in boys declined at all income levels. However, between 2011 and 2019, both the prevalence of overweight in girls and the prevalence of obesity (applying the WHO and IOTF criteria) and the prevalence of central obesity in both sexes remained stable.

CONCLUSIONS

The prevalence of overweight and the prevalence of obesity in schoolchildren aged 6-9 years in Spain remain high. Between 2011 and 2019, the prevalence of overweight in children aged 6-8 years and in children whose parents had university degrees decreased, whereas obesity in boys, overweight and obesity in girls and central obesity in both sexes remained stable.

Reduction of sugar, salt and fat content in foods over the period 2016-2021 in Spain: the National Food Reformulation Plan

BACKGROUND/OBJECTIVES

Population´s dietary intake of saturated fat, sodium, and sugars is higher than the current recommendations in Spain and most European countries. Nationwide food reformulation strategies have the potential to improve nutritional quality; however, evaluations are only available in a few countries and are difficult to compare. This study shows the degree of compliance with the nutrient reduction objectives included in a 4-year (2016-2020) Spanish food reformulation initiative.

METHODS

In 2016, baseline median nutrient content was established for 57 food subcategories. Agreed reduction (%) expressed as the median content to be reached by 2020 was set as the objective. In 2021, Spanish Food Safety and Nutrition Agency (AESAN) collected mandatory nutritional information from 3118 products belonging to the food subcategories included in the PLAN. Median nutrient content was calculated and compared with baseline data established in 2016 and PLAN objectives.

RESULTS

Median nutrient content reduction was observed in all food subcategories. Relative reductions (%) ranged from 0.6 to 60% for added sugars, 4.8 to 33.3% for salt, 4.5 to 78.3% for saturated fat, and 24.9 to 36% for total fat. PLAN objectives were achieved in all subcategories except for one. The number of products involved, belonging to the highly consumed food categories, shows the potential of national reformulation strategies to improve the nutritional quality of the diet.

CONCLUSION

Compliance with nutrient reduction agreements was 99%; however, the variability of nutrient content within subcategories shows that there is room for further reduction in selected nutrients and food subcategories.

Socioeconomic and gender inequalities in childhood obesity in Spain

INTRODUCTION

Childhood obesity is inversely associated with household socioeconomic status in high-income countries. Our aim was to explore the association between childhood weight status and household socioeconomic status in Spain in relation to family characteristics, perceptions and lifestyle habits and the school environment.

METHODS

We performed a descriptive analysis of child weight status according to family socioeconomic factors and mediating variables based on data from the ALADINO 2019 study in a sample of 16,665 schoolchildren representative of the population aged 6-9 years in Spain.

RESULTS

The prevalence of childhood obesity in households with low socioeconomic status (26.8% boys; 20.4% girls) was, in both sexes, twice as high as in those with higher socioeconomic status (12.1% boys; 8.7% girls). Unhealthy eating habits, sedentary lifestyles (mainly in girls) and the presence of screens in the bedroom (more prevalent in boys) were more frequent in school-aged children from low-income households. On the other hand, in the most disadvantaged households, a history of breastfeeding and physical activity (especially in girls) were less frequent. Similarly, schools attended by children from low-income households were less likely to have their own kitchens and indoor gymnasiums or offer sports activities.

CONCLUSION

A lower household socioeconomic status was associated with poorer dietary and physical activity habits and certain characteristics of the family and school environments that mediate the inverse association between household socioeconomic status and the prevalence of childhood obesity. Girls were less physically active and reported more sedentary lifestyles, while boys had greater access to screens. Interventions to combat childhood obesity should address the identified inequalities.

Are Spanish Surveys Ready to Detect the Social Factors of Obesity?

The social origins of obesity are now recognised: a problem that is initially biological is today a public health problem with a social origin. This paper raises the question of whether the official statistical sources used to understand changes in diet are able to detect this shift in analysis. After reviewing the social factors that explain obesity, we examine the official Spanish statistics that can inform about dietary changes: the ENS National Health Survey, the EPF Family Budget Survey, and the EET Time Use Survey, all carried out by the Spanish Statistical Office. All of them include socio-demographic variables and some locational variables. However, the lack of health variables in the economic survey and the lack of social variables in the health survey prevent the gathering of reliable scientific evidence to offer solid support in stopping the obesity epidemic. Food has become particularly important as one of the main areas where unhealthy decisions and choices involve high risk; the situation also demonstrates the relationship between social inequality and obesity. Obesity is now understood in a radically different way and the origin of the problem lies in social and cultural factors. The current surveys do not provide the resources to capture the social causality of obesity, but slight modifications would help expand their capabilities and offer reliable scientific evidence to stop the obesity epidemic.

Mapping of Outdoor Food and Beverage Advertising around Spanish Schools

Overweight and obesity rates have increased worldwide in the last decades. The marketing strategies of food considered to be unhealthy significantly exacerbate the childhood obesity dilemma. Studies typically analyze the content of advertisement in television, movies, or social media, but there is a gap in the assessment of the real-life promotion of food and beverages around the schools. The primary aim of the study was to assess the products advertised around public and concerted schools in three cities in the north of Spain, and to categorize them as healthy (core) or unhealthy (discretionary). The secondary aim was to describe the types of food and beverages in advertisements, as well as to determine the density of core and discretionary product advertisements. A cross-sectional descriptive study was carried out between September and December 2021. The units of analysis were outdoor food and beverage advertisements that were located around public and concerted schools of three cities in the north of Spain. We found 104 schools that met the criteria. We identified 6469 products advertised, 35.1% core and 61.2% discretionary, observing significant differences (p < 0.001) among the cities. Fruit (core) and alcohol (discretionary) were the most heavily advertised products. In conclusion, children attending schools located in the assessed cities are currently exposed to a significant amount of discretionary product advertisement, a situation that should be regulated.

Influence of an Educational Intervention on Eating Habits in School-Aged Children

A health promotion intervention directed at preventing unhealthy habits in relation to physical exercise, hygiene habits, diet and personal relationships can lead to a decrease in diseases during adulthood and obtaining a better quality of life. The intervention had a participative and multidisciplinary nature, and it was developed by health professionals, teachers and parents for school children. It promoted healthy lifestyle habits around food by working on four areas through video lessons, interactive talks, practical and theoretical−practical classes and an individual project on behalf of the student where they had to design healthy menus. We randomly selected, by stratified multistage sampling, three public primary education schools. A sample of 479 students registered during the 2014/2015 academic year aged between 6−12 years were included in the study. After the educational intervention, we found a significant reduction in the BMI of the students (p < 0.001). For breakfast, the overweight or obese children modified their usual food consumption after the intervention for a healthier breakfast based on fruit juice and bread instead of sugary snacks (p < 0.001). Regarding eating habits during the mid-morning break, there was a decrease in the consumption of sugary snacks (p < 0.001) and an increase in the consumption of fruits and sandwiches. We found that, after the intervention, the excessive consumption of pasta for the main meal reduced in favor of an increase in the consumption of proteins and different beans and pulses (p > 0.001). Educational interventions on healthy lifestyle habits carried out in children during their early years improve and correct unhealthy habits.

[Childhood obesity in Spain and associated factors]

Childhood obesity is an important public health problem, also in Spain. The ALADINO study, in the context of the COSI strategy of the WHO European office, monitors the weight status of Spanish schoolchildren aged 6 to 9 years, and analyzes the associated factors. Data from the 2019 wave indicate that 23.3 % of schoolchildren are overweight and 17.3 % are obese. A high percentage of schoolchildren eat breakfast regularly, although breakfast quality can be improved. The frequency of consumption of fruits and vegetables is low, even lower than that of other countries participating in the COSI strategy. In terms of lifestyle, more than 70 % of schoolchildren are active, although this percentage is lower than the European average. Screen exposure time is also shorter than in other countries, but this habit may be improved in a high percentage of schoolchildren. There is a lower percentage of schoolchildren with obesity who have breakfast or are active compared to those of normal weight, while they are more sedentary, spend fewer hours sleeping, and are more likely to have a TV or electronic devices in their room. It is a priority to promote access to healthier diets and the promotion of more active and less sedentary lifestyles, both in the family and at school, from an early age.

[Weight status in the 6- to 9-year-old school population in Spain: results of the ALADINO 2019 Study]

INTRODUCTION

childhood obesity is a public health problem whose prevalence has grown steadily in recent decades.

OBJECTIVE

to describe the weight status of schoolchildren aged 6 to 9 years in Spain in 2019, and their associated factors.

METHODS

ALADINO is a cross-sectional study in schoolchildren aged 6 to 9 years, representative of the Spanish population, and aligned with the Child Obesity Surveillance Initative of the WHO Regional Office for Europe. Participants' weight, height, and abdominal circumference were measured, defining weight status according to different standards (WHO, IOTF, and Orbegozo). A questionnaire on lifestyle and socio-demographic characteristics was administered to parents.

RESULTS

a total of 16,665 schoolchildren from 276 schools were measured. Excess weight was observed in 40.6 %: 23.3 % overweight and 17.3 % obesity, with obesity being more prevalent in boys and overweight in girls, both increasing with age. The prevalence of abdominal obesity was 22.6 %. Excess weight decreased by 3.9 percentage points since 2011, mainly due to overweight in boys. Obesity remained stable. Excess weight was more prevalent in schoolchildren with less healthy eating and physical activity habits, and in families with a lower socioeconomic status.

CONCLUSIONS

the prevalence of excess weight is high, although it has declined since 2011 and remains stable since 2015 among schoolchildren aged 6-9 years in Spain, this reduction being mainly due to a decrease in overweight in children. It is necessary to continue promoting healthy habits from the earliest stages of life, thus reducing health inequalities.

Percentiles and Principal Component Analysis of Physical Fitness From a Big Sample of Children and Adolescents Aged 6-18 Years: The DAFIS Project

Assessing physical fitness has emerged as a proxy of the health status of children and adolescents and therefore as relevant from a public health point of view. DAFIS is a project included in Plan Galicia Saudable (Healthy Galicia Plan) of the regional government of Galicia (Spain). DAFIS consists of an on-line software devoted to record the results of a standard physical fitness protocol carried out as a part of the physical education curriculum. The aims of this study were: to obtain normative values of physical fitness of the Galician school population evaluated in the DAFIS project, and to identify a reduced number of components and tests able to capture a significant amount of the variability in the physical fitness of children and adolescents. From an initial sample of 27784 records, 15287 cases (7543 males, 7744 females) were considered after filtering. Generalized Additive Models for Location, Scale and Shape were used for obtaining percentile curves and tables for each sex. Furthermore, a principal components analysis was performed, selecting the number of components by applying the Kaiser's rule and selecting a subset of variables considering the correlation between each variable and the components. Percentile curves and normative values are reported for each test and sex. Physical fitness was better in boys than in girls throughout age groups, except for flexibility that was consistently higher in girls. Two main components were detected throughout age groups: the first one representing body composition and partially cardiorespiratory fitness and the second one muscular fitness. For boys and girls, waist to height ratio had the highest correlations with the first component in four out of six age groups. The highest correlation with the second component, was most frequently observed for the handgrip test both in boys and girls (four out of six age groups). This study provides evidence about the utility of school community actions like DAFIS aimed to track the health-related fitness of children and adolescents. The results suggest that fat mass distribution (i.e., waist to height ratio and waist circumference) and muscular performance (mainly handgrip) concentrate a high proportion physical fitness variance.